Healthcare Provider Details

I. General information

NPI: 1417369380
Provider Name (Legal Business Name): KORE OT & PT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 E 88TH ST SUITE 004
BROOKLYN NY
11236-3949
US

IV. Provider business mailing address

942 E 87TH ST
BROOKLYN NY
11236-3909
US

V. Phone/Fax

Practice location:
  • Phone: 347-391-5060
  • Fax:
Mailing address:
  • Phone: 347-391-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034140-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number034140-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number034140-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number034140-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number034140-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number034140-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number034140-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number034140-1
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number63 017099
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number63 017099
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number63 017099
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number63 017099
License Number StateNY
# 13
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number63 017099
License Number StateNY
# 14
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number63 017099
License Number StateNY

VIII. Authorized Official

Name: MRS. KATIA JOLLY SOUVERAIN
Title or Position: OWNER
Credential: PT, OTR/L, MBA, CEAS
Phone: 347-391-5060